<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Globe Business Application Form</title>
<style>
/*
form        { width: 300px; padding:0; margin-bottom: 18px; }
fieldset    { border:0; padding-bottom: 9px;  }
label       { display: block; cursor: pointer; line-height: 20px; text-shadow: 0 -1px 0 rgba(0,0,0,.2); font-size:14px; color:#000; }
.radios     { padding-top: 18px; background: url(divider.png) repeat-x 0 0; }
.label_check input,
.label_radio input  { margin-right: 5px;}
#footer     { width: 100%; text-align: center; font-size: 12px; }
#footer a   { padding: 2px 10px; margin: 0 2px; color: #999; background: #ddd; text-decoration: none; border-radius: 10px; -webkit-border-radius: 10px; -moz-border-radius: 10px; -khtml-border-radius: 10px; }
#footer a:hover,
#footer a:focus { color: #fff; background: #333; background: rgba(0,0,0,.3); }

.has-js .label_check,
.has-js .label_radio    { padding-left: 34px; height:37px; margin: 17px 0 64px 20px; }
.has-js .label_radio    { background: url(radio-off.png) no-repeat; }
.has-js .label_check    { background: url(check-off.png) no-repeat; }
.has-js label.c_on      { background: url(check-on.png) no-repeat; }
.has-js label.r_on      { background: url(radio-on.png) no-repeat; }
.has-js .label_check input,
.has-js .label_radio input  { position: absolute; left: -9999px; }
*/


div#form1 dl {
	position:relative;
	margin: 0 0 0 50px;
	font-size: 28px;
	font-weight: bold;
	font-family: Arial, Helvetica, sans-serif;
}
div#form1 dt {
	margin:0;
	padding:0;
	vertical-align: middle;
	height:30px;
	width: auto;
	border:1px #fff solid;
}
div#form1 label {
	margin:0 4px 0 6px;
	padding:0;
}
div#left-sect dl {
	float:left;
	margin:-10px 0 0 0;
	font-size: 28px;
	font-weight: bold;
	font-family: Arial, Helvetica, sans-serif;
}
div#left-sect dt {
	margin:0;
	padding:0;
	vertical-align: middle;
	height:30px;
	width: auto;
	border:1px green solid;
}
dl {
	margin: 10px 0 0 417px;
	font-size: 28px;
	font-weight: bold;
	font-family: Arial, Helvetica, sans-serif;
}
dt {
	margin:0;
	padding:0;
	vertical-align: middle;
	height:50px;
	width: 626px;
}
</style>
</head>
<body>
<table width="9605" border="0" cellspacing="0" cellpadding="0" height="2700">
  <tr>
    <td align="left" valign="top" background="/images/print/bg-inner.jpg">


<table border="0" cellpadding="0" cellspacing="0" width="9605">
        <tr valign="top" height="300">
          <td height="362" colspan="3"></td>
          <td width="3305" rowspan="2">
          <div style="clear:both;height:290px;"></div>
            <dl>
              <dt>Coffee</dt>
            </dl>
            <div style="clear:both;height:10px;"></div>
            <dl>
              <dt>Milk</dt>
            </dl>
            <div style="clear:both;height:110px;"></div>
            <dl>
              <dt>
                <div style="margin:0px 0px 0px -240px">x</div>
              </dt>
            </dl>
            <div style="clear:both;height:10px;"></div>
            <dl>
              <dt> <div style="margin:0px 0px 0px -240px">x</div></dt>
            </dl>


            <div style="margin:250px 0px 0px 70px; padding:0px 0px 0px 360px; height:auto; width:900px">

            	<div style="width:500px; height:auto">
                	Nominated Potpaid
                </div>


                <div style="width:500px; height:auto; margin:90px 0px 0px 0px">
                	Corporate ID
                </div>

                <div style="height:1400px; width:200px"></div>

            </div>

              <div style="width:700px; height:auto; margin:0px 0px 0px 100px">
                	Corporate ID
                </div>

                <div style="width:700px; height:auto; margin:70px 0px 0px 180px">
                	Date
                </div>

                <div style="width:500px; height:auto; margin:25px 0px 0px 330px">
                	Date
                </div>


            </td>
        </tr>
        <tr valign="top">
          <td width="2700" height="1606"><div style="height:100px;"></div>
            <div style="clear:both;"></div>
            <div id="form1" style="font-size:30px;width:auto;height:auto;margin:0 0 0 64px;">
              <table width="1057" border="0" cellpadding="0" cellspacing="0" style="margin: 85px 0 0 300px;">
                <tr>
                  <td height="44">&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>
                    <?php $checkedBg = ($application['existing_subscriber'] == 1) ? 'check--on.png' : 'check--off.png' ?>
                    <img src="/images/print/<?php echo $checkedBg ?>" style="margin:21px 0 0 60px" />
                  </td>
                  <td>
                    <?php $checkedBg = ($application['existing_subscriber'] == 1) ? 'check--off.png' : 'check--on.png' ?>
                    <img src="/images/print/<?php echo $checkedBg ?>" style="margin:21px 0 0 116px" />
                  </td>
                </tr>
                <tr>
                  <td></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td height="61">
                    <?php $checkedBg = (strlen($application['globe_mobile_access_code'].$application['globe_mobile_phone_number']) > 0) ? 'check--on.png' : 'check--off.png' ?>
                    <img src="/images/print/<?php echo $checkedBg ?>" style="margin:45px 0 0 30px" />
                  </td>
                  <td></td>
                  <td><div style="clear:both;height:20px;"></div>
                    <?php if(strlen($application['globe_mobile_access_code']) > 0): ?>
                    <?php for($i = 0; $i < strlen($application['globe_mobile_access_code']); $i++): ?>
                    <label><?php echo $application['globe_mobile_access_code'][$i] ?></label>
                    <?php endfor; ?>
                    <?php endif; ?>
                  </td>
                  <td><div style="clear:both;height:20px;"></div>
                    <div style="margin:10px 0 0 60px;">
                      <label>1</label>
                      <label>2</label>
                      <label>3</label>
                      <label>4</label>
                      <label>2</label>
                      <label>3</label>
                      <label>4</label>
                    </div></td>
                </tr>
                <tr>
                  <td height="34">&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
                <tr>
                  <td height="50"><input type="checkbox" name="" value=""   style="margin:20px 0 0 30px"/></td>
                  <td>&nbsp;</td>
                  <td><div style="clear:both;height:12px;"></div>
                    <label>1</label>
                    <label>2</label>
                    <label>3</label>
                    <label>4</label></td>
                  <td><div style="clear:both;height:12px;"></div>
                    <div style="margin:10px 0 0 60px;">
                      <label>1</label>
                      <label>2</label>
                      <label>3</label>
                      <label>4</label>
                      <label>2</label>
                      <label>3</label>
                      <label>4</label>
                    </div></td>
                </tr>
                <tr>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
                <tr>
                  <td height="13"></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td><input type="checkbox" name="" value=""  style="margin: 10px 0 0 35px" /></td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
                <tr>
                  <td height="40"></td>
                  <td></td>
                  <td></td>
                  <td></td>
                </tr>
                <tr>
                  <td width="281" height="44"><div style="margin:0px 0 0 35px; float:left">x</div>
                    <div style="margin:0px 0 0 83px; float:left">x</div>
                    <div style="margin:0px 0 0 75px; float:left">x</div></td>
                  <td width="311"><div style="margin:0px 0 0 45px; float:left">x</div>
                    <div style="margin:0px 0 0 85px; float:left">Others</div></td>
                  <td width="154"></td>
                  <td width="311"><div style="margin:0px 0 0 20px; float:left">x</div>
                    <div style="margin:0px 0 0 150px; float:left">x</div></td>
                </tr>
              </table>
              <table width="1057" height="1348" border="0" cellpadding="0" cellspacing="0" style="margin: 0 0 0 300px;">
                <tr>
                  <td colspan="3"><div style="clear:both;height:57px;"></div>
                    <dl>
                      <dt>Coffee</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:47px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:47px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td><table border="0" cellpadding="0" cellspacing="0" >
                      <tr>
                        <td><div style="clear:both;height:34px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                      </tr>
                    </table></td>
                  <td colspan="2"><div style="clear:both;height:34px;"></div>
                    <dl>
                      <dt>Coffee, Milk &amp; Tea</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="3"><table border="0" cellpadding="0" cellspacing="0">
                      <tr>
                        <td width="417" height="59"><div style="margin:0px 0px 0px 65px">x</div></td>
                        <td width="165"><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td width="59"><div id="left-sect">
                            <dl>
                              <dt>Milk</dt>
                            </dl>
                          </div></td>
                      </tr>
                      <tr>
                        <td height="37"><div style="margin:0px 0px 0px 65px">x</div></td>
                        <td><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td><div id="left-sect">
                            <dl>
                              <dt>Milk</dt>
                            </dl>
                          </div></td>
                      </tr>
                      <tr>
                        <td height="60"><div style="margin:0px 0px 0px 65px">x</div></td>
                        <td></td>
                        <td>&nbsp;</td>
                      </tr>
                    </table>
                    <!--



                                <input type="checkbox" name="" value=""  style="margin:-2px 0 0 65px" />

                                <input type="checkbox" name="" value=""  style="margin:-2px 0 0 70px;float:left;" />
                                   <div id="left-sect">
                                     <dl>
                                       <dt>Milk</dt>
                                     </dl>
                                   </div>

                                <input type="checkbox" name="" value=""  style="margin:4px 0 0 65px" />

                               <input type="checkbox" name="" value=""  style="margin:20px 0 0 70px;float:left;" />
                                   <div id="left-sect">
                                     <dl>
                                       <dt>Milk</dt>
                                     </dl>
                                   </div>
                                <input type="checkbox" name="" value=""  style="margin:22px 0 0 65px" />-->
                  </td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:20px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:20px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:10px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="4"></td>
                </tr>
                <tr>
                  <td colspan="2"><div style="clear:both;height:10px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                  <td width="497"><div style="clear:both;height:10px;"></div>
                    <dl>
                      <dt style="margin:0px 0px 0px 160px">Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td height="34" colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td width="348" height="34"><dl>
                      <dt>Milk</dt>
                    </dl></td>
                  <td width="212"><dl>
                      <dt style="margin:0px 0px 0px 100px">Milk</dt>
                    </dl></td>
                  <td height="34"><dl>
                      <dt style="margin:0px 0px 0px 160px">Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td height="34" colspan="3"><div style="clear:both;height:5px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td height="34" colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="3"><table width="1039">
                      <tr>
                        <td width="484"><div style="clear:both;height:10px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                        <td width="543"><div style="clear:both;height:10px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                      </tr>
                    </table></td>
                </tr>
                <tr>
                  <td height="34" colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="3"><div style="clear:both;height:10px;"></div>
                    <dl>
                      <dt>Milk</dt>
                    </dl></td>
                </tr>
                <tr>
                  <td colspan="3"><table width="1039">
                      <tr>
                        <td width="484"><div style="clear:both;height:40px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                        <td width="543"><div style="clear:both;height:40px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                      </tr>
                    </table></td>
                </tr>
                <tr>
                  <td colspan="3"><table width="1039">
                      <tr>
                        <td width="484"><div style="clear:both;height:40px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                        <td width="543"><div style="clear:both;height:40px;"></div>
                          <dl>
                            <dt>Milk</dt>
                          </dl></td>
                      </tr>
                    </table></td>
                </tr>
                <tr>
                  <td height="51" colspan="3">&nbsp;</td>
                </tr>
                <tr>
                  <td height="42" colspan="3"><table width="1053">
                      <tr>
                        <td width="70" height="36"></td>
                        <td width="24"><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td width="182">&nbsp;</td>
                        <td width="24"><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td width="224">&nbsp;</td>
                        <td width="23"><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td width="291">&nbsp;</td>
                        <td width="23"><div style="margin:0px 0px 0px 5px">x</div></td>
                        <td width="152"></td>
                      </tr>
                    </table></td>
                </tr>
              </table>
              <div style="margin:40px 0px 0px 330px">
                <table width="1039" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="495">Maria Clara</td>
                    <td width="544">June 25 1935</td>
                  </tr>
                  <tr>
                    <td colspan="2" style="padding:50px 0px 0px 0px">Clerk</td>
                  </tr>
                  <tr>
                    <td width="495" style="padding:50px 0px 0px 0px">Maria Clara</td>
                    <td width="544" style="padding:50px 0px 0px 60px">092091339</td>
                  </tr>
                </table>
              </div>
            </div>







           <div style="position:absolute; top:610px; left:1640px; background:transparent">
           	<table width="1000" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td>

                <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td>employer/business name</td>
                  </tr>
                </table>

<div style="margin:65px 0px 0px 0px">
<table width="1000" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td width="34" height="20" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td width="473">&nbsp;</td>
    <td width="25" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td width="241">&nbsp;</td>
    <td width="227">&nbsp;</td>
  </tr>
  <tr>
    <td height="30" align="left" valign="top">&nbsp;</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td height="20" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td>&nbsp;</td>
    <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td height="28" align="left" valign="top" style="padding:0px 0px 0px 10px">&nbsp;</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td height="25" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td>&nbsp;</td>
    <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">other please specify</td>
  </tr>
</table>
</div>

                <div style="margin:100px 0px 0px 0px">
				 <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td>complete business address</td>
                  </tr>
                </table>
                </div>

                 <div style="margin:50px 0px 0px 0px">
				 <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td>complete business address</td>
                  </tr>
                </table>
                </div>

                 <div style="margin:50px 0px 0px 0px">
				 <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="638">bgy/municipality or town</td>
                    <td width="362">bgy/municipality or town</td>
                  </tr>
                </table>
                </div>

                 <div style="margin:50px 0px 0px 0px">
				 <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="452">office telephone number</td>
                    <td width="308">area code</td>
                     <td width="240">phone number</td>
                  </tr>
                </table>
                </div>

                 <div style="margin:55px 0px 0px 0px">
				 <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="467">bgy/municipality or town</td>
                    <td width="533">bgy/municipality or town</td>
                  </tr>
                </table>
                </div>



                 <div style="margin:70px 0px 0px 0px">
				 <table width="676" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td width="35" style="padding:0px 0px 0px 20px">x</td>
    <td width="443">&nbsp;</td>
    <td width="24" style="padding:0px 0px 0px 10px">x</td>
    <td width="174">&nbsp;</td>
  </tr>
  <tr>
    <td height="28">&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td height="25" style="padding:0px 0px 0px 20px">x</td>
    <td>&nbsp;</td>
    <td style="padding:0px 0px 0px 10px">x</td>
    <td>&nbsp;</td>
  </tr>
</table>
                </div>


                <div style="margin:95px 0px 0px 0px">
                <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td>employer/business name</td>
                  </tr>
                </table>
                </div>


               <div style="margin:50px 0px 0px 0px">
                <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="264">employer/business name</td>
                    <td width="255">employer/business name</td>
                    <td width="244">employer/business name</td>
                    <td width="237">employer/business name</td>
                  </tr>
                </table>
                </div>


                <div style="margin:120px 0px 0px 0px">
                <table width="1000" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="38" align="left" valign="top" style="padding:0px 0px 0px 20px">x</td>
                    <td width="443"></td>
                     <td width="27" style="padding:0px 0px 0px 0px">x</td>
                      <td width="492"></td>
                  </tr>
                </table>
                </div>


                 <div style="margin:165px 0px 0px 0px">
               <table width="880" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td width="40" height="25" align="left" valign="top" style="padding:5px 0px 0px 20px">x</td>
    <td width="91">&nbsp;</td>
    <td width="749" align="left" valign="top">gplan</td>
  </tr>
  <tr>
    <td height="26" align="left" valign="top">&nbsp;</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">&nbsp;</td>
  </tr>
  <tr>
    <td align="left" valign="top" style="padding:5px 0px 0px 20px">x</td>
    <td>&nbsp;</td>
    <td>gplan</td>
  </tr>
  <tr>
    <td height="28" align="left" valign="top">&nbsp;</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">&nbsp;</td>
  </tr>
  <tr>
    <td height="28" align="left" valign="top" style="padding:5px 0px 0px 20px">x</td>
    <td>&nbsp;</td>
    <td align="left" valign="top">gplan</td>
  </tr>
</table>
 </div>


              <div style="margin:100px 0px 0px 0px">
               	 <table width="500" border="0" cellspacing="0" cellpadding="0">
                   <tr>
                     <td width="36" height="25" align="left" valign="top" style="padding:0px 0px 0px 18px">x</td>
                     <td width="89">&nbsp;</td>
                     <td width="375"></td>
                   </tr>
                   <tr>
                     <td height="24">&nbsp;</td>
                     <td>&nbsp;</td>
                     <td>&nbsp;</td>
                   </tr>
                   <tr>
                     <td height="27" style="padding:0px 0px 0px 18px">x</td>
                     <td>&nbsp;</td>
                     <td align="left" valign="top">New Subscription</td>
                   </tr>
                 </table>
               </div>





                             <div style="margin:70px 0px 0px 0px">
               	 <table width="977" border="0" cellspacing="0" cellpadding="0">
                   <tr>
                     <td width="41" height="25" align="left" valign="top" style="padding:0px 0px 0px 18px">x</td>
                     <td width="436"></td>
                     <td width="27">x</td>
                     <td width="473"></td>
                   </tr>
                   <tr>
                     <td height="50">&nbsp;</td>
                     <td>&nbsp;</td>
                     <td>&nbsp;</td>
                     <td>&nbsp;</td>
                   </tr>
                   <tr>
                     <td height="27" style="padding:0px 0px 0px 18px">x</td>
                     <td>&nbsp;</td>
                     <td align="left" valign="top" style="padding:2px 0px 0px 0px">x</td>
                     <td align="left" valign="top" style="padding-left:80px">others</td>
                   </tr>
                 </table>
               </div>


             <div style="margin:80px 0px 0px 0px">
             <table width="700" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td align="left" valign="top" style="padding:0px 0px 0px 190px">type</td>
              </tr>
            </table>
             </div>

             <div style="margin:30px 0px 0px 0px">
             <table width="700" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td align="left" valign="top" style="padding:0px 0px 0px 190px">
                <div style="margin:0px 0px 0px 45px; width:20px; height:20px; float:left">x</div>
                <div style="margin:0px 0px 0px 230px; width:20px; height:20px; float:left">x</div>
                <div style="clear:both"></div>
                </td>
              </tr>
            </table>
             </div>



              <div style="margin:60px 0px 0px 0px">
             <table width="1000" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td align="left" valign="top" style="padding:0px 0px 0px 0px">
                <div style="margin:0px 0px 0px 45px; width:330px; height:20px; float:left">x</div>
                <div style="margin:0px 0px 0px 230px; width:220px; height:20px; float:left; padding-left:80px">x</div>
                <div style="clear:both"></div>
                </td>
              </tr>
            </table>
             </div>

              <div style="margin:45px 0px 0px 0px">
             <table width="1000" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td align="left" valign="top" style="padding:0px 0px 0px 20px">
              SIM CARD NUMBER
                </td>
              </tr>
            </table>
             </div>









                </td>
              </tr>
            </table>

           </div>








            </td>
          <td width="2411"><div style="margin:230px 0px 0px 100px">
              <table width="2250" border="0" cellspacing="0" cellpadding="0">
                <tr>
                  <td width="1070">Netbooster Asia</td>
                  <td width="1180" style="padding:0px 0px 0px 130px">No. of lines applied for</td>
                </tr>
                <tr>
                  <td width="1070" style="padding:50px 0px 0px 0px">Netbooster Asia</td>
                  <td width="1180" style="padding:50px 0px 0px 190px">Authorized Corporate</td>
                </tr>
                <tr>
                  <td width="1070" style="padding:50px 0px 0px 0px">Netbooster Asia</td>
                  <td width="1180" style="padding:50px 0px 0px 130px"><div style="float:left">Position in campny</div>
                    <div style="float:left; padding:0px 0px 0px 360px">0909090909</div>
                    <div style="float:left; padding:0px 0px 0px 290px">jdelacruz@yahoo.com</div></td>
                </tr>
                <tr>
                  <td width="1070" style="padding:60px 0px 0px 0px"><table width="1058" border="0" cellspacing="0" cellpadding="0">
                      <tr>
                        <td width="619">City</td>
                        <td width="439" style="padding:0px 0px 0px 03px">Postal</td>
                      </tr>
                    </table></td>
                  <td width="1180" style="padding:60px 0px 0px 170px"> Authorized Corporate </td>
                </tr>
                <tr>
                  <td width="1052" style="padding:50px 0px 0px 0px">
                  <table width="1052" height="40" border="0" cellspacing="0" cellpadding="0">
                      <tr>
                        <td width="29" style="padding:0px 0px 0px 10px">x</td>
                        <td width="118">&nbsp;</td>
                        <td width="27" style="padding:0px 0px 0px 10px">x</td>
                        <td width="154">&nbsp;</td>
                        <td width="26"> style="padding:0px 0px 0px 10px">x</td>
                        <td width="149">&nbsp;</td>
                        <td width="26" style="padding:0px 0px 0px 10px">x</td>
                        <td width="157">&nbsp;</td>
                        <td width="24" style="padding:0px 0px 0px 10px">x</td>
                        <td width="153">&nbsp;</td>
                        <td width="27" style="padding:0px 0px 0px 10px">x</td>
                        <td width="162">&nbsp;</td>
                      </tr>
                    </table></td>
                  <td width="544" style="padding:50px 0px 0px 60px"><div style="margin:0px 0px 0px 30px">
                      <table width="1078" border="0" cellspacing="0" cellpadding="0">
                        <tr>
                          <td width="373">Manager</td>
                          <td width="391" style="padding:0px 0px 0px 50px">090909090909</td>
                          <td width="314" style="padding:0px 0px 0px 50px">manager@yahoo.com</td>
                        </tr>
                      </table>
                    </div></td>
                </tr>
                <tr>
                  <td width="1070" style="padding:60px 0px 0px 0px"><div style="padding:22px 0px 0px 0px">
                      <table width="1062" height="312" border="0" cellpadding="0" cellspacing="0">
                        <tr>
                          <td width="31" height="27" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td width="336">&nbsp;</td>
                          <td width="28" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                          <td width="290">&nbsp;</td>
                          <td width="377" style="padding:0px 0px 0px 10px">x</td>
                        </tr>
                        <tr>
                          <td height="28">&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="27" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td>&nbsp;</td>
                          <td align="left" valign="top" style="padding:0px 0px 0px 8px">x</td>
                          <td>&nbsp;</td>
                          <td style="padding:0px 0px 0px 10px">x</td>
                        </tr>
                        <tr>
                          <td height="28">&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="25" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td>&nbsp;</td>
                          <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                          <td>&nbsp;</td>
                          <td style="padding:0px 0px 0px 10px">x</td>
                        </tr>
                        <tr>
                          <td height="28">&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="26" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td>&nbsp;</td>
                          <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                          <td>&nbsp;</td>
                          <td style="padding:0px 0px 0px 10px">x</td>
                        </tr>
                        <tr>
                          <td height="28">&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="25" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td>&nbsp;</td>
                          <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                          <td>&nbsp;</td>
                          <td style="padding:0px 0px 0px 10px">x</td>
                        </tr>
                        <tr>
                          <td height="28">&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td height="" align="left" valign="top" style="padding:0px 0px 0px 15px">x</td>
                          <td>&nbsp;</td>
                          <td align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                      </table>
                      <table width="1064" border="0" cellspacing="0" cellpadding="0">
                        <tr>
                          <td style="padding:50px 0px 0px 0px"><table width="1060" border="0" cellspacing="0" cellpadding="0">
                              <tr>
                                <td width="27" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="126">&nbsp;</td>
                                <td width="19" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="159" align="left" valign="top">&nbsp;</td>
                                <td width="22" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="154" align="left" valign="top">&nbsp;</td>
                                <td width="22" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="158" align="left" valign="top">&nbsp;</td>
                                <td width="22" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="157" align="left" valign="top">&nbsp;</td>
                                <td width="21" align="left" valign="top" style="padding-left:8px">x</td>
                                <td width="173" align="left" valign="top">&nbsp;</td>
                              </tr>
                            </table>
                            <div style="padding:55px 0px 0px 0px">
                              <table width="672" border="0" cellspacing="0" cellpadding="0">
                                <tr>
                                  <td width="25" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                                  <td width="165" align="left" valign="top">&nbsp;</td>
                                  <td width="22" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                                  <td width="194" align="left" valign="top">&nbsp;</td>
                                  <td width="24" align="left" valign="top" style="padding:0px 0px 0px 10px">x</td>
                                  <td width="242" align="left" valign="top">&nbsp;</td>
                                </tr>
                              </table>
                            </div></td>
                        </tr>
                      </table>
                    </div></td>
                  <td width="1180" align="left" valign="top" style="padding:40px 0px 0px 130px"><div style="margin:0px 0px 0px 30px">
                      <table width="1078" border="0" cellspacing="0" cellpadding="0">
                        <tr>
                          <td style="padding:10px 0px 0px 0px">after sale</td>
                        </tr>
                      </table>
                    </div>
                    <div style="margin:60px 0px 0px 0px">
                      <table width="1078" border="0" cellspacing="0" cellpadding="0">
                        <tr>
                          <td align="left" valign="top"><table width="1078" border="0" cellspacing="0" cellpadding="0">
                              <tr>
                                <td align="left" valign="top"><table width="1078" border="0" cellspacing="0" cellpadding="0">
                                    <tr>
                                      <td align="center" valign="top"><div style="width:300px; height:20px; float:left; margin-right:50px">position in company</div>
                                        <div style="width:300px; height:20px; float:left;margin-right:100px">contact no.</div>
                                        <div style="width:270px; height:20px; float:left">email add</div></td>
                                    </tr>
                                  </table>
                                  <div style="margin:55px 0px 0px 30px">
                                    <table width="1078" border="0" cellspacing="0" cellpadding="0">
                                      <tr>
                                        <td>after sale</td>
                                      </tr>
                                    </table>
                                  </div>
                                  <div style="margin:55px 0px 0px 30px">
                                    <table width="1078" border="0" cellspacing="0" cellpadding="0">
                                      <tr>
                                        <td width="309" align="center">after sale</td>
                                        <td width="390" align="center">after sale</td>
                                        <td width="379" align="center">after sale</td>
                                      </tr>
                                    </table>
                                  </div>
                                  <div style="margin:55px 0px 0px 30px">
                                    <table width="1078" border="0" cellspacing="0" cellpadding="0">
                                      <tr>
                                        <td width="523" align="left" style="padding:25px 0px 0px 20px"><table width="436" height="29" border="0" cellpadding="0" cellspacing="0">
                                            <tr>
                                              <td width="27" height="26" style="padding:0px 0px 0px 10px">x</td>
                                              <td width="409">&nbsp;</td>
                                            </tr>
                                          </table>
                                          <div style="padding:70px 0px 0px 0px">
                                            <table width="436" height="52" border="0" cellpadding="0" cellspacing="0">
                                              <tr>
                                                <td width="27" height="26"></td>
                                                <td width="409"  style="padding:0px 0px 0px 50px">Sample Account Number</td>
                                              </tr>
                                              <tr>
                                                <td height="26" style="padding:0px 0px 0px 10px">x</td>
                                                <td>&nbsp;</td>
                                              </tr>
                                            </table>
                                          </div></td>
                                        <td width="555" align="center"><table width="436" height="29" border="0" cellpadding="0" cellspacing="0">
                                            <tr>
                                              <td width="27" height="26" style="padding:20px 0px 0px 15px">x</td>
                                              <td width="409">&nbsp;</td>
                                            </tr>
                                          </table>
                                          <div style="padding:70px 0px 0px 0px">
                                            <table width="436" height="52" border="0" cellpadding="0" cellspacing="0">
                                              <tr>
                                                <td width="27" height="26"></td>
                                                <td width="409"  style="padding:0px 0px 0px 55px">Sample Account Number</td>
                                              </tr>
                                              <tr>
                                                <td height="26" style="padding:0px 0px 0px 15px">x</td>
                                                <td>&nbsp;</td>
                                              </tr>
                                            </table>
                                          </div></td>
                                      </tr>
                                    </table>
                                  </div></td>
                              </tr>
                            </table></td>
                        </tr>
                      </table>
                    </div></td>
                </tr>
              </table>
            </div>
            <div style="padding:315px 0px 0px 100px; float:left">
              <table width="1073" height="470" border="0" cellpadding="0" cellspacing="0">
                <tr align="left" valign="top">
                  <td width="50" height="53" style="padding:0px 0px 0px 15px">x</td>
                  <td width="487" style="padding:0px 0px 0px 15px"></td>
                  <td width="49">&nbsp;</td>
                  <td width="487">&nbsp;</td>
                </tr>
                <tr>
                  <td align="left" valign="top">&nbsp;</td>
                  <td align="left" valign="middle" style="padding-left:20px">company name</td>
                  <td align="left" valign="top">&nbsp;</td>
                  <td align="left" valign="middle"  style="padding-left:20px">attention</td>
                </tr>
                <tr align="left" valign="top">
                  <td height="111">&nbsp;</td>
                  <td valign="middle"  style="padding:15px 0px 0px 20px">address</td>
                  <td>&nbsp;</td>
                  <td align="left" valign="middle"  style="padding-left:20px; padding-top:20px">department</td>
                </tr>
                <tr align="left" valign="top">
                  <td height="116">&nbsp;</td>
                  <td colspan="3" align="left" valign="middle" style="padding:20px 0px 0px 20px">building name</td>
                </tr>
                <tr align="left" valign="top">
                  <td align="left" valign="middle"  style="padding:0px 0px 0px 15px">x</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
              </table>
            </div>


             <div style="height:228px; width:500px; background:transparent"></div>
            <div style="float:left; width:1000px; padding:0px 0px 0px 120px; position:relative">

                 <div style="padding:0px 0px 0px 15px; width:20px;">x</div>
                 <div style="padding:42px 0px 0px 15px; width:20px;">x</div>

<div style="padding:120px 0px 0px 0px">
<table width="1069" height="436" border="0" cellpadding="0" cellspacing="0">
  <tr align="left" valign="top">
    <td width="253" height="63">Department</td>
    <td width="284"  style="padding:0px 0px 0px 40px">contact number</td>
     <td width="261" align="left" valign="top" style="padding:0px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:0px 0px 0px 40px">contact number</td>
  </tr>
  <tr align="left" valign="top">
    <td height="93" style="padding:40px 0px 0px 0px">Department</td>
    <td style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
  </tr>
  <tr align="left" valign="top">
    <td height="97" style="padding:40px 0px 0px 0px">Department</td>
    <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
    <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
  </tr>
  <tr>
    <td height="94" align="left" valign="top" style="padding:40px 0px 0px 0px">Department</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
  </tr>
  <tr align="left" valign="top">
    <td align="left" valign="top" style="padding:40px 0px 0px 0px">Department</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
     <td align="left" valign="top" style="padding:40px 0px 0px 40px">contact number</td>
    <td align="left">&nbsp;</td>
  </tr>
</table>

         </div>


<div style="position:absolute; bottom: -120px; left: 140px;">corporate code</div>

            </div>




            <div style="clear:both"></div>





            <div style="height:0px; background:transparent; width:auto"></div>
            <div style="padding:0px 0px 0px 150px; float:left;">
              <table width="1012" height="182" border="0" cellpadding="0" cellspacing="0">
                <tr>
                  <td height="46" colspan="2"></td>
                  <td width="146" style="padding-left:15px">x</td>
                  <td width="247" align="left" valign="top" style="padding:15px 0px 0px 14px">x</td>
                  <td width="163"></td>
                </tr>
                <tr>
                  <td width="228" align="left" valign="top" style="padding:8px 0px 0px 15px">x</td>
                  <td width="228"></td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
                <tr>
                  <td align="left" valign="top" style="padding:22px 0px 0px 15px">x</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                  <td>&nbsp;</td>
                </tr>
                <tr>
                  <td colspan="5" align="left" valign="top" style="padding:50px 0px 0px 70px">x</td>
                </tr>
                <tr>
                  <td colspan="5"  style="padding:50px 0px 0px 70px">x </td>
                </tr>
              </table>
            </div>


             <div style="clear:both"></div>



            </td>
          <td width="1189">

          <div style="padding:430px 0px 0px 0px">

                <div style="width:450px; height:20px; float:left; margin:0px 0px 0px 120px; text-align:center">Name</div>
                <div style="width:200px; height:20px;float:left; margin:0px 0px 0px 200px;text-align:center">June 25 1985</div>
                <div style="clear:both"></div>

                <div style="width:450px; height:20px; margin:70px 0px 0px 120px; text-align:center">Name</div>

                 <div style="width:450px; height:20px; margin:190px 0px 0px 120px; float:left; text-align:center">Endorsed by</div>
                  <div style="width:200px; height:20px;float:left; margin:190px 0px 0px 200px;text-align:center">June 25 1985</div>
                  <div style="clear:both"></div>

                   <div style="width:450px; height:20px; margin:70px 0px 0px 120px; text-align:center">Endorsed by</div>

                   <div style="height:860px; width:100px;"></div>

                   <div style="background:url(/images/print/blue-bg.png) no-repeat; width:1033px; height:75px; margin:0px 0px 0px 80px; padding-top:125px">
                        <div style="width:450px; height:20px; margin:0px 0px 0px 120px; float:left; text-align:center">Endorsed by</div>
                        <div style="width:200px; height:20px;float:left; margin:0px 0px 0px 200px; text-align:center">June 25 1985</div>
                         <div style="clear:both"></div>
                   </div>

                     <div style="background:url(/images/print/lblue-bg.png) no-repeat; width:1033px; height:197px; margin:27px 0px 0px 80px; padding-top:125px">
                         <div style="width:450px; height:20px; margin:0px 0px 0px 120px; float:left; text-align:center">Endorsed by</div>
                         <div style="width:200px; height:20px;float:left; margin:0px 0px 0px 200px; text-align:center">June 25 1985</div>
                         <div style="clear:both"></div>
                         <div style="width:450px; height:20px; margin:110px 0px 0px 120px; float:left; text-align:center">Endorsed by</div>
                         <div style="width:200px; height:20px;float:left; margin:110px 0px 0px 200px; text-align:center">June 25 1985</div>
                         <div style="clear:both"></div>
                     </div>






          </div>






          </td>
        </tr>
      </table>





    </td>
  </tr>
</table>
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